March 29, 2024
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Baldacci criticizes feds on drug plan Database yet to list names of all eligible

AUGUSTA – An angry Gov. John Baldacci blasted federal officials Friday for moving forward with the new federal drug benefit program that takes effect Sunday even though the names of thousands of Mainers are not yet entered into Medicare computers.

Despite a top federal official’s assertions that the system would be updated by Sunday, Baldacci said, “This program is simply not ready for implementation. It is irresponsible to go forward with this when they are clearly not ready.”

The governor added that his administration was taking steps to ensure that Mainers previously covered under state drug plans would continue to get the drugs they need come Sunday even if the state had to pay for medications until the situation could be resolved.

“People will be able to get their drugs, I can promise you that,” Baldacci said in an interview Friday, “but it’s going to be at a cost to the state.”

More than 200,000 seniors in Maine will become eligible for the new Medicare Part D prescription drug benefit on Jan. 1.

But Baldacci said Friday that several thousand eligible Mainers are not yet accounted for in the federal database.

Brian Cresta, regional administrator for the federal Department of Health and Human Services, denied Friday that the program was not ready to be implemented. He said everyone would be able to get the drugs they need under the new plan, even if they are not in the computer system.

“There is a lot of misinformation being put out in Maine,” he said. “We have backups in place to make sure everyone can get access to the drugs they need.”

But according to state officials, only half of Maine’s 45,000 so-called dual eligibles – people who qualify for both Medicaid and Medicare – are in the federal computer database. Another 12,000 beneficiaries of the state’s Drugs for the Elderly and Disabled program who are to be transitioned into the new federal program also are not yet recorded in the federal computers.

Until the federal computer lists are updated, the state maintains, pharmacies will not know which one of several plans available under Medicare Part D covers a particular individual and therefore what drugs are covered for that individual.

Jude Walsh, pharmacy affairs director of the Governor’s Office of Health Policy and Finance, said Friday that several Maine pharmacists have told her this week they are concerned there are problems with the federal database.

U.S. Sen. Olympia Snowe, R-Maine, also expressed outrage Friday that the federal computer system was not up to date and contained inaccuracies.

“It is simply unfathomable to me that two days before the new Medicare prescription drug benefit is set to go into effect the very computer system needed to verify eligible low-income seniors for this new program is not accurate and up to date,” Snowe said in a statement. “CMS [Centers for Medicaid and Medicare Services] must take immediate and urgent action to remedy these serious problems that are of life-or-death importance to the people of Maine and the nation.”

Cresta, the regional administrator for the federal DHHS, said Friday, however, that the names that weren’t in the system yet should be in by Sunday and that even if they weren’t, there are backups in place to make sure individuals get the medications they need.

For instance, he said, elderly Mainers can present their Medicare cards to a pharmacist Sunday and be automatically enrolled in a plan if they are not already in the system.

He also said that the state only recently had provided federal officials with some of the names of Mainers previously enrolled in the state’s Drugs for the Elderly and Disabled program.

“We just got the data a few short days ago,” Cresta said. “That is going into the computer this afternoon, and I believe it will all be in by the end of the day.”

U.S. Sen. Susan Collins, R-Maine, said in a statement issued Friday afternoon that CMS officials had assured her the concerns raised by Baldacci would not result in any Mainers being denied benefits when the program begins this weekend.

“This is a very serious matter, and I have been assured by CMS that no beneficiary will be denied prescription drug coverage when the new plan takes effect on January 1,” Collins said. “It is imperative that the concerns raised by the state of Maine are addressed immediately.”

Baldacci remained steadfast that he expects problems with the new federal program despite Cresta’s assertions and that, until the situation can be resolved, the state will continue to cover prescriptions where needed for Mainers previously enrolled in state drug plans.

The governor acknowledged he may be stretching his authority to order drug coverage at state expense, but he believes he has the authority to order emergency coverage.

“I have a responsibility under the [state] Constitution to protect the public health and safety,” he said. “I cannot allow seniors to not get the medicines they need. I believe I have that authority, and I am using that authority.”

The governor said the cost to the state likely would be “in the millions of dollars,” but he said he would not allow seniors to go without needed drugs. He said a person who does not get a life-sustaining drug could end up hospitalized or even die.

“I can’t let that happen,” he said. “I won’t let that happen.”

The state has increased the hours of operation of the help line it set up earlier this month, which averaged more than 15,000 calls a day this week. It will operate from 8 a.m. to 5 p.m. Saturday and Sunday and 8 a.m. to 7:30 p.m. Monday. The state’s Pharmacy Helpline can be reached toll-free at (866) RxMaine, or (866) 796-2463.


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